Rheumatology Commons^™

Eosinophilic Granulomatosis With Polyangiitis (Churg Strauss Syndrome) – A Case Report, Rudrani Mukherjee, Bhanukumar M

Digital Journal of Clinical Medicine

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg Strauss syndrome, is a rare small vessel vasculitis characterized by asthma, eosinophilia, and systemic involvement. This case report presents a 51-year-old man with a history of asthma, who presented with neurological symptoms including blurring of vision, bilateral ptosis, and altered sensorium. The patient had a previous history of cervical and lumbar spine surgeries for symptoms attributed to spondylosis. Further examination revealed hyperpigmented lesions on the limbs, wasting of small muscles, and foot drop.

Investigations showed eosinophilia and thrombocytosis on blood analysis, with bone marrow aspiration revealing eosinophilic and megakaryocytic hyperplasia. The …

Extrinsic Allergic Alveolitis: A Systematic Review Of Hla-Dr In Pigeon Breeder’S Disease, Dylan Thibaut, Ryan A. Witcher, Anitha Kunnath, James Toldi

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Introduction: Pigeon Breeder’s Pneumonitis (PBP) results due to a complex pathophysiology that includes exposure to avian antigens. Susceptibility has been linked to human leukocyte antigen (HLA) class II, though consensus has not been reached. The goal of this systematic review is to further elucidate the association between PBP and HLA-DR subtypes.

Methods: Databases utilized included PubMed, Google Scholar, ScienceDirect, and Cochrane Library. Inclusion required a minimum of three studies in English presenting HLA-DR alleles of PBP and control subgroups. Exclusion was due to insufficient data or non-feasible control groups. Forest plots were created for HLA-DR subtypes’ association …

Pustular Psoriasis And The Potential Therapeutic Usage Of An Il-36 Receptor Monoclonal Antibody, Jeannel T. Miclat, Shafik Habal

Research Day

Pustular psoriasis is an uncommon subtype of psoriasis that dramatically affects the quality of life of affected patients. Pustules can emerge anywhere along the trunk, limbs, soles, palms, and fingers, which debilitates the functionality of these appendages. Currently, there are no approved treatments for pustular psoriasis in the US; off-label usage of psoriasis vulgaris medications is usually prescribed. These treatments are insufficient for patients with difficult to manage or severe forms of pustular psoriasis. Psoriasis vulgaris biologic medications mainly target the IL-17 and IL-23 axis. However, novel clinical findings have demonstrated that pustular psoriasis’s central inflammatory axis depends on the …

Bone Marrow Transplant For Macrophage Activation Syndrome In Systemic Juvenile Idiopathic Arthritis, Shailly Gaur, Michael J. Holland, J Allyson Hays, Ibrahim A. Ahmed

Research Days

Background

The recognition of macrophage-activation-syndrome (MAS) in the setting of systemic-juvenileidiopathic-arthritis (sJIA) is complex, but a necessary distinction given emerging treatment options. With overlapping clinical manifestations including fever, end-organ involvement and lymphadenopathy, there is a focus on laboratory values to differentiate MAS from a sJIA flare. Once parameters are met, multiple treatment modalities can be considered, as monotherapy or in combination, including steroids, immunosuppression, chemotherapy, intravenous immunoglobulin, and cytokine-directed biologics. Given the long-term morbidity and mortality associated with progressive inflammation and immune dysregulation due to MAS with sJIA, it is imperative to regain control over this complication. However, these treatments …

Bone Marrow Transplant For Macrophage Activation Syndrome In Systemic Juvenile Idiopathic Arthritis​, Shailly Gaur, Michael J. Holland, J Allyson Hays, Ibrahim A. Ahmed

Posters

7yo w/ systemic juvenile idiopathic arthritis who developed macrophage activation syndrome and interstitial lung disease non-responsive to steroids, immunosuppression, and directed biologics with significant adverse reactions who required chemotherapy and eventual bone marrow transplant leading to complete resolution of symptoms.

Graves' Disease And Major Histocompatibility Complex Class Ii: A Meta-Analysis Of Hla-Dq And Hla-Drb1, Dylan Thibaut, Connor Sweeney, Shannon South, Mohamed Hussein

Advances in Clinical Medical Research and Healthcare Delivery

Background: Human leukocyte antigen (HLA) class II has shown potential in determining prognosis, understanding medication reactions, and predicting onset of Graves’ disease. The aim of this study is to further investigate the association between Graves’ disease and HLA class II, specifically HLA-DQ and HLA-DR, via meta-analysis to find HLAs that can be further examined for prognostic reasons.

Methods: Statistical analysis was performed to determine if variants of HLA-DQA1, HLA-DQB1, or HLA-DRB1 were associated with significantly altered odds of Graves’ disease. A minimum of three studies pertaining to a particular HLA was required for inclusion. Studies were excluded if …

Rheumatoid Vasculitis Presenting With Incidental Renal Infarcts: Case Report And Literature Review, Fatima Halilu, Howard Hauptman

Journal of Community Hospital Internal Medicine Perspectives

Rheumatoid vasculitis is a rare and late complication of rheumatoid arthritis, affecting small to medium sized vessels. Inflammation in the vessel wall produces an occlusive vasculopathy with downstream infarction. We present the case of a 70-year-old female with long standing stable RA status post recent COVID-19 vaccination admitted with community acquired Legionnaires disease found to have an incidental renal infarct on chest imaging without a clear etiology. She improved from a respiratory standpoint but then had a fever spike with repeat imaging showing a second renal infarct and CT angiography showing extensive beading with aneurysmal dilation in the bilateral hepatic …

It Is Not Pneumocystis Jiroveci (Pcp), It Is Cyclophosphamide-Induced Pneumonitis, Mery Bartl, Yilen Karen Ng-Wong, Blesset Alexander, Jose Gomez Casanovas, Josenny L. Rodriguez-Paez, Andres Suarez, Christine Loftis

School of Medicine Publications and Presentations

Cyclophosphamide (CYC) is an immunosuppressive medication used to treat life-threatening complications of various rheumatic diseases like vasculitis and systemic lupus erythematosus. A rare side effect of this medication is pneumonitis, which occurs in less than 1% of patients. We describe a case of an 83-year-old woman with a past medical history of microscopic polyangiitis, who presented with progressive dyspnea at rest, exacerbated on exertion, and associated with orthopnea that was attributed to CYC-induced pneumonitis. Three months before this presentation, the patient was diagnosed with antineutrophil cytoplasmic antibodies (ANCA)-positive pauci-immune crescentic and necrotizing glomerulonephritis and started on CYC. On admission, a …

Rapid Onset Hydralazine-Induced Antineutrophil Cytoplasmic Antibody (Anca) Associated Vasculitis Presenting With Hemoptysis And Kidney Failure: Case Report, Rachel E. Easter, Andinet Gizaw, Natalie Klein

Internal Medicine Publications

Hydralazine-induced vasculitis can be challenging to recognize and diagnose as presenting symptoms vary and can mimic other conditions or diseases, however, swift intervention and treatment is key in halting progression of the disease and providing patients with the best possible outcomes. A 71-year-old African American female presented to the emergency department with weakness, fatigue, anemia, blood-streaked sputum, fever, chills, and severe myalgias. Hydralazine was prescribed to treat resistant hypertension eight months prior to presentation. Hydralazine was discontinued on hospital day (HD) 4. Pertinent laboratory values showed elevated inflammatory markers, positive antinuclear antibody (ANA), negative rheumatoid factor (RF), normal complement levels, …

Metformin-Induced Giant Cell Arteritis: An Uncommon Case Of Drug-Induced Vasculitis, Christine Angeles, Wendy Lee

South Atlantic Division Research Day 2023

No abstract provided.

An Iceberg I Can’T Handle: A Qualitative Inquiry On Perceptions Towards Paediatric Rheumatology Among Healthcare Workers In Kenya, Angela Migowa, Sasha Bernatsky, Anthony Ngugi, Helen E. Foster, Peter Muriuki, Adelaide Lusambili, Stanley Luchters

Paediatrics and Child Health, East Africa

Background: Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to nonspecialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management.

Purpose: We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya.

Methods: We conducted 12 focus group discussions with clinical officers (third-tier community health …

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Vasculitides, Julianna S. Kang, Julia Nunley, Tiffany Ho, Mavra Masood, Fnu Nutan, Beth Rubinstein

Open and Affordable Course Content at VCU

Cutaneous Manifestations of Vasculitides is a Powerpoint based learning module that begins with the definition of terms and findings often found in vasculitis, followed by a review of several systemic vasculitides, highlighting how characteristic cutaneous lesions may be predictive of the vessel of involvement as well as the associated histologic changes. Moreover, significant clinical and laboratory findings utilized to make the correct diagnosis will be emphasized. This module is not meant to be an exhaustive review of vasculitis, but to serve as an introduction to understanding disease processes and how systemic vasculitis and skin findings interrelate.

It is part of …

Dermatologic Manifestations Of Rheumatic Disease: Malignant Cutaneous Tumors, Divya Shan, Julianna S. Kang, Allison Cinats, Julia R. Nunley, Beth Rubinstein

Open and Affordable Course Content at VCU

Malignant Cutaneous Tumors is a Powerpoint-based learning module that focuses on skin cancers. It begins with the definition of terms and findings, followed by a review of several clinical cases. The goal of the module is to provide the students with the ability to differentiate the most common types of skin cancer and precancerous lesions and gain an awareness of cutaneous lymphomas. This module will include images and clinical findings from diverse skin tones to prepare students to identify cutaneous findings in a heterogeneous patient population. This module is not a comprehensive review of skin cancers but an introduction to …

Why A High Titer Rheumatoid Factor And Joint Pain Should Not Automatically Translate Into A Diagnosis Of Rheumatoid Arthritis, Saba Ashraf, Julio Gonzalez-Paoli

West Florida Division Research Day 2023

No abstract provided.

Gender Dysphoria In Adolescents With Ehlers-Danlos Syndrome., Jordan T. Jones, William R. Black, Christine Moser, Eric T. Rush, Lindsey Malloy-Walton

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic.

METHODS: A retrospective chart review was performed and it was …

Treatment Of Severe Swallowing Dysfunction In Systemic Sclerosis With Ivig: Role Of Antimuscarinic Antibodies, Fabian A Mendoza, Anthony J. Dimarino, Sidney Cohen, Christopher Adkins, Shady Abdelbaki, Satish Rattan, Christopher Cao, Susie Denuna-Rivera, Sergio A. Jimenez

Division of Gastroenterology and Hepatology Faculty Papers

Oropharyngeal and esophageal dysmotility can cause serious clinical complications such as aspiration pneumonia, cachexia, and sarcopenia, with a resulting increase in mortality and disability. The current standard of care for the treatment of SSc-associated swallowing dysfunction is mainly supportive, although severe cases are usually refractory to conventional management. Recent studies have shown that the abnormal production of functional autoantibodies such as anti-cholinergic muscarinic receptor III antibodies may participate in the pathogenesis of SSc-associated gastrointestinal dysmotility and may provide a novel target for therapeutic intervention. We describe two patients with severe and rapid onset of SSc-associated severe swallowing dysfunction and esophageal …

Lupus Enteritis In The Absence Of A Lupus Flare. A Case Report And Review Of Literature, Fatima Halilu, Anum Qureshi, Brenton Nash

Journal of Community Hospital Internal Medicine Perspectives

Lupus enteritis is a rare manifestation seen in systemic lupus erythematosus (SLE). Its diagnosis can be challenging as symptoms frequently overlap many gastrointestinal disorders, imaging findings are not specific, and endoscopic features are infrequently diagnostic. Moreover, enteritis can occur in isolation without other systemic manifestations or even elevated inflammatory markers (1). Here is presented the case of a 22-year-old female with known SLE manifested by lupus nephritis complicated by end-stage renal disease who presented with abdominal pain. She had leukocytosis with thickened bowel loops, ascites, “target sign”, “comb sign” and patent abdominal vessels on CT imaging. The differential diagnoses considered …

Cryoglobulinemic Vasculitis In The Setting Of Sjögren's Syndrome: A Case Report And Review Of The Literature, Delena Vanvalkenburg, Christopher Gibson, Dasha Valeria Lopez, Brittany Hill, Steven Lindsey

Medical Research Day

Introduction: Cryoglobulinemic vasculitis results from the deposition of cryoglobulins, proteins that precipitate in cold temperatures, within the circulation. The resultant vascular occlusion causes widespread end-organ damage. While more commonly associated with lymphoproliferative or infectious diseases such as HCV and HIV, cryoglobulinemia also occurs in patients with Sjögren's syndrome, a chronic autoimmune disorder affecting the lacrimal and salivary glands. Case: We present a case of a 48-year-old Caucasian male with a past medical history significant for Raynaud phenomenon, recurrent nephrolithiasis, and episodic urticaria over the last year. He presented to the emergency department with complaints of fever, dyspnea, productive cough, severe …

Evidence-Based Role Of Aspirin In Giant Cell Arteritis: A Literature Review, Anum Qureshi, Fatima Halilu, Sam W. Serafi, Howard Hauptman, Tristan Flack

Journal of Community Hospital Internal Medicine Perspectives

Giant cell arteritis (GCA), or temporal arteritis, is a medium to large vessel vasculitis seen in the elderly. Its presentation varies from fever of unknown origin to cranial ischemic complications including complete vision loss. The early initiation of steroids is key to preventing complications of GCA. Here we discuss the role of aspirin in the treatment of GCA, both as an antithrombotic agent and its increasingly utilized antiinflammatory properties. The aim of this review article is to examine the evidence behind the rationale of aspirin use as an adjunct to steroids for the prevention of cranial ischemic complications.

Enhancing Physician Perspectives Of Skilled Occupational Therapy Services For Patients With Rheumatoid Arthritis, Valerie S. Trinidad

Department of Occupational Therapy Entry-Level Capstone Projects

This Capstone Project, with a focus in research, sought to identify a relationship between self-reported functional performance and participation restriction as described by satisfaction with one’s execution or participation in a described occupation. A correlational study design was employed under the mentorship of Dr. Thomas Decker, EdD, OTD, OTR/L who oversaw all IRB processes, documentation, study development and deployment, as well as co-authored and provided mentorship for creation of a publishable manuscript of this project. The established Health Assessment Questionnaire Disability Index (HAQ-DI) and the newer Keele Assessment of Participation (KAP) were the two outcome measures of focus for surveying …